I'M CATHERINE LAW WITH THE
COMMUNICATIONS TEAM AT THE
NATIONAL CENTER FOR
COMPLEMENTARY AND INTEGRATIVE
HEALTH OR NCCIH AT THE NATIONAL
IBS TEUTS OF HEALTH.
-- INSTITUTES OF
HEALTH.
ON BEHALF OF THE DIRECTOR,
DR. HELENE LANGEVIN I'D LIKE TO
WELCOME YOU TO OUR INTEGRATIVE
MEDICINE RESEARCH LECTURE SERIES
FOR A PRESENTATION BY
DR. MICHELLE MARTIN, UNIVERSITY
OF TENNESSEE HEALTH SCIENCE
CENTER.
DR. MARTIN'S TALK IS ENTITLED
"WELL-BEING AND THE ECONOMIC
BURDEN OF DISEASE: WHAT ARE WE
LEARNING FROM CANCER SURVIVORS?"
I'M NOW PLEASED TO TURN THINGS
OVER TO DR. DAVID SHURTLEFF,
DEPUTY DIRECTOR OF NCCIH, TO
INTRODUCE OUR SPEAKER.
DR. SHURTLEFF, PLEASE TAKE IT
AWAY.
>>WELL, THANK YOU, KATHRYN, AND
HI, EVERYONE.
WELCOME TO THE SECOND OF THREE
LECTURES FOR THE SPRING 2022
NCCIH'S INTEGRATIVE MEDICINE
RESEARCH LECTURE SERIES.
TODAY'S LECTURE IS ON THE THEME
OF EMOTIONAL WELL-BEING.
IT REFLECTS SEVERAL KEY RESEARCH
INTERESTS OF NCCIH, INCLUDING
ADVANCING RESEARCH ON WHOLE
PERSON HEALTH, FOSTERING
RESEARCH ON HEALTH PROMOTION AND
RESTORATION, RESILIENCE AND
DISEASE PREVENTION, AND
INCREASING OUR UNDERSTANDING OF
THE ROLE OF EMOTIONAL WELL-BEING
AND HEALTH, INCLUDING WELLNESS
AND TO SUPPORT RESILIENCE.
TO EXPLORE THE CONCEPT FURTHER,
IN 2018, NCCIH AND THE OFFICE OF
BEHAVIORAL AND SOCIAL SCIENCE
RESEARCH HERE AT THE NIH ALONG
WITH SEVERAL OTHER INSTITUTES
CO-SPONSORED A ROUNDTABLE ON
ADVANCING EMOTIONAL WELL-BEING
RESEARCH.
THE ROUNDTABLE IS AVAILABLE ON
THE NCCIH WEBSITE FOR THOSE WHO
MAY BE INTERESTED IN THOSE
PROCEEDINGS.
SUBSEQUENT TO THAT, IN 2021, NIH
AWARDED MIGHT HAVE NEW RESEARCH
NETWORKS TO ALLOW INVESTIGATORS
TO REFINE AND TEST KEY CONCEPTS
THAT ADVANCE -- TO ADVANCE THE
STUDY OF EMOTIONAL WELL-BEING.
NCCIH, THE NATIONAL INSTITUTE ON
AGING, CHILD HEALTH AND HUMAN
DEVELOPMENT, AND THE OFFICE OF
BEHAVIORAL AND SOCIAL SCIENCES
RESEARCH AND SEVERAL OTHER NIH
COMPONENTS CONTRIBUTED TO
FUNDING, AND YOU'LL HEAR ABOUT
ONE OF THOSE NETWORKS TODAY FROM
OUR SPEAKER, DR. MICHELLE
MARTIN.
AND FOR MORE INFORMATION ON
NCCIH'S RESEARCH PRIORITY,
PLEASE REVIEW OUR STRATEGIC PLAN
FOR 2021 TO 2025, WHICH IS
AVAILABLE ON OUR WEBSITE.
NOW I'D LIKE TO WELCOME OUR
FEATURED SPEAKER THIS AFTERNOON,
DR. MICHELLE MARTIN.
PROFESSOR IN THE COLLEGE OF
MEDICINE'S DEPARTMENT OF
PREVENTIVE MEDICINE AT THE
UNIVERSITY OF TENNESSEE HEALTH
SCIENCE CENTER.
SHE IS ALSO CO-DIRECTOR OF THE
TENNESSEE CLINICAL AND
TRANSLATIONAL SCIENCE INSTITUTE,
AND FOUNDING DIRECTOR OF THE
CENTER FOR INNOVATION AND HEALTH
EQUITY RESEARCH, A COMMUNITY
CANCER ALLIANCE FOR TRAN
TRANSFORMATIVE CHANGE.
THROUGH THE CENTER, DR. MARTIN
AND HER TEAM WORK TO REDUCE THE
CANCER BURDEN ACROSS THE
CONTINUUM AND IMPROVE HEALTH
OUTCOMES FOR PEOPLE DIAGNOSED
WITH CANCER WHO ARE FROM RACIAL
OR ETHNIC MINORITY POPULATIONS.
DR. MARTIN IS ALSO A MULTIPLE
PRINCIPAL INVESTIGATOR OF THE
EMOTIONAL WELL-BEING AND
ECONOMIC BURDEN RESEARCH NETWORK
THAT I MENTIONED PREVIOUSLY.
SHE ALSO HOLDS A PH.D. IN
CLINICAL PSYCHOLOGY FROM THE
UNIVERSITY OF ALABAMA BIRMINGHAM
AND COMPLETED HER CLINICAL
INTERNSHIP AT WEST VIRGINIA
UNIVERSITY DURING GRADUATE
TRAINING AND COMPLETEDGR
UATE TRAINING AT THE
UNIVERSITY OF ALABAMA AT
BIRMINGHAM.
THE NIH FUNDERS OF HER RESEARCH
INCLUDE NCCIH, THE NATIONAL
CANCER INSTITUTE, AND THE
NATIONAL INSTITUTE ON MINORITY
HEALTH AND HEALTH DISPARITIES.
SO WITH THAT, MICHELLE, WELCOME,
AND I TURN THE MIC OVER TO YOU.
>> OKAY.
THANK YOU, DR. SHURTLEFF, VERY
MUCH FOR THAT KIND INTRODUCTION,
AND FOR THE INVITATION TO BE
HERE TODAY.
IT TRULY IS AN HONOR TO BE AN
INVITED SPEAKER FOR THIS
IMPORTANT LECTURE SERIES.
I'M ESPECIALLY EXCITED BECAUSE
OF THE INSTITUTE'S FOCUS ON
WHOLE PERSON HEALTH.
I BELIEVE MY TALK TODAY WHICH
WILL TALK ABOUT HEALTH IN
MULTIPLE DOMAINS FOR CANCER
SURVIVORS REALLY ALIGNS NICELY
WITH THAT.
TODAY'S PRESENTATION, I'VE
ORGANIZED IT INTO THREE PARTS.
I'LL BEGIN FIRST WITH A VERY
HIGH LEVEL OVERVIEW OF CANCER
SURVIVORSHIP IN THE UNITED
STATES.
AND THIS IS REALLY AN OVERVIEW
TO PROVIDE A CONTEXT FOR THE
PRESENTATION OVERALL.
IN THE SECOND PART OF THE
PRESENTATION, I'LL PRESENT TO
YOU QUALITY OF LIFE AND DOMAINS
OF WELL-BEING, SPECIFICALLY,
PHYSICAL WELL-BEING AND
SYMPTOMS, PSYCHOLOGICAL
WELL-BEING, SOCIAL WELL-BEING,
AND SPIRITUAL WELL-BEING.
FOR PHYSICAL WELL-BEING AND
SYMPTOMS, PSYCHOLOGICAL
WELL-BEING AND SPIRITUAL
WELL-BEING, I'LL PROVIDE YOU
SOME EXAMPLES OF RESEARCH
STUDIES CURRENTLY IN THE FIELD
THAT ARE ADDRESSING THE NEEDS OF
CANCER SURVIVORS IN THESE
DOMAINS.
WITH RESPECT TO SOCIAL
WELL-BEING, I'LL GO A LITTLE BIT
DEEPER AND THAT'S WHEN I'LL TALK
ABOUT OUR EMOTIONAL WELL-BEING
AND ECONOMIC BURDEN OF DISEASE
RESEARCH NETWORK.
I'LL CONCLUDE THE PRESENTATION
WITH SOME REFLECTIONS THAT
HOPEFULLY PROVIDES SOME NICE
TALKING POINTS THAT WE COULD
DISCUSS FURTHER IN THE QUESTION
AND ANSWER PART OF THE
PRESENTATION.
SO BEGINNING WITH THE OVERVIEW
OF CANCER SURVIVORSHIP.
I LOVE TO BE ABLE TO SHARE GOOD
NEWS AND WE HAVE GOOD NEWS WHEN
WE THINK ABOUT CANCER.
WE HAVE MADE SIGNIFICANT
PROGRESS IN THE FIGHT AGAINST
CANCER, DUE TO INCREASES IN
EARLY DETECTION OF CANCER AS
WELL AS IMPROVED TREATMENTS.
AS SUCH, WE HAVE A NUMBER OF
CANCER SURVIVORS LIVING WITH US
TODAY.
THE FIRST PART OF THIS SLIDE
SHOWS AS OF JANUARY 1ST, 2019,
WE HAD ABOUT 16.9 MILLION
INDIVIDUALS LIVING IN THE U.S.
WHO ARE CANCER SURVIVORS.
IT IS EXPECTED BY JANUARY 1ST OF
2030 THAT THAT NUMBER WILL
EXCEED 21 MILLION.
CANCER SURVIVORS LIVING WITH US.
THIS NEXT SLIDE I THINK EVEN
ILLUSTRATES IT BETTER, AS YOU
CAN SEE THE INCREASE OF CANCER
SURVIVORS FROM 1970 KNIFE
ESTIMATED TO THE YEAR 2040.
THE YEAR 2040, WE EXPECT THAT
26.1 MILLION AMERICANS WILL BE
CANCER SURVIVORS, THE MAJORITY
OF THOSE BEING IN THE OLDER
POPULATION.
THIS IS WONDERFUL NEWS THAT WE
HAVE MANY CANCER SURVIVORS.
AS YOU THINK ABOUT TREATING
DISEASE, HOWEVER, WE ALSO KNOW
IT'S IMPORTANT TO THINK ABOUT
THE WHOLE PATIENT.
AS SUCH, A FEW YEARS AGO, THE
INSTITUTE OF MEDICINE HAD A
PUBLICATION TITLED "CANCER CARE
FOR THE WHOLE PATIENT."
WITH A REAL CALL FOR US TO FOCUS
ON PSYCHOSOCIAL HEALTH.
AND THEY DEFINE PSYCHOSOCIAL
HEALTH AS SERVICES THAT ARE
PSYCHOLOGICAL AND SOCIAL
SERVICES AND INTERVENTIONS THAT
ENABLE PATIENTS, THEIR FAMILIES,
AND HEALTHCARE PROVIDERS TO
OPTIMIZE BIOMEDICAL HEALTHCARE
AND TO MANAGE THE
PSYCHOLOGICAL/BEHAVIORAL AND
SOCIAL ASPECTS OF ILLNESS AND
ITS CONSEQUENCES SO AS TO
PROMOTE BETTER HEALTH.
AND THIS IS WHERE I BELIEVE
QUALITY OF LIFE AND WELL-BEING
REALLY PLAYS A ROLE.
IN THIS NEXT SLIDE, I'M
PRESENTING TO YOU A MODEL USED
BY PERMISSION FROM THE CITY OF
HOPE.
AS YOU CAN SEE FROM THIS MODEL,
WHEN WE THINK ABOUT WHOLE
HEALTH, WHEN WE THINK ABOUT
QUALITY OF LIFE OF CANCER
SURVIVOR, WE THINK ABOUT FOUR
DOMAINS.
WE HAVE THE PHYSICAL WELL-BEING
AND SYMPTOMS DOMAIN THAT
INCLUDES ACTIVITIES SUCH AS
FUNCTIONAL ACTIVITIES, ONE'S
STRENGTH, ONE'S FATIGUE, SLEEP
AND REST, ONE'S OVERALL PHYSICAL
HEALTH, FERTILITY, AND PAIN.
WHEN WE CONSIDER PSYCHOLOGICAL
WELL-BEING, THE SECOND DOMAIN,
WE THINK ABOUT INDIVIDUALS'
PERCEPTION OF THEIR CONTROL OF
THEIR SITUATION, ANXIETY,
DEPRESSION, ENJOYMENT/LEISURE
ACTIVITIES, FEAR OF RECURRENCE,
THEIR COGNITION AND ATTENTION,
INDIVIDUALS MAY -- INDIVIDUALS
WITH CANCER TALK ABOUT HAVING
CHEMO BRAIN, THAT THEY JUST
DON'T THINK AS WELL, LIKE THEY
USED TO.
DISTRESS OF DIAGNOSIS AND
CONTROL OF TREATMENT.
WHEN WE CONSIDER SOCIAL
WELL-BEING, WE CONSIDER FAMILY
DISTRESS, ROLES AND
RELATIONSHIPS, AFFECTION/SEXUAL
FUNCTION, APPEARANCE, ENJOYMENT
AGAIN ALSO FITS HERE, ISOLATION,
FINANCES, AND WORK.
AND FINALLY, THE FOURTH DOMAIN,
SPIRITUAL WELL-BEING.
MEANING OF ILLNESS, RELIGIOSITY,
TRAN 16 DENSE, HOPE,
UNCERTAINTY, AND INNER STRENGTH.
WHILE IT'S IMPORTANT TO
CONCEPTUALIZE WELL-BEING, I
THINK IT'S ALSO IMPORTANT TO
HEAR FROM CANCER SURVIVORS, SO I
HAVE A SHORT VIDEO FOR YOU NOW
SO YOU CAN HEAR SOMEONE'S STORY.
>> EVERY DAY THE SUN IS SHINING
ON YOU, WHEN IT'S NOT, EVEN WHEN
IT SHOULD BE.
THERE'S A LOT OF SCARS ON THE
INSIDE THAT PEOPLE DON'T KNOW
AND DON'T SEE.
AND THEY DON'T UNDERSTAND.
A FEW MONTHS AFTER MY FINAL
REMISSION, I'D GO TO THE GYM AND
STRUGGLE WITH JUST THE BAR.
I WOULD JUST STRUGGLE WITH
TRYING TO WALK ON A TREADMILL
FOR MORE THAN TWO MINUTES.
YOU WANT THE IMMEDIATE
SATISFACTION OF PROGRESS.
YOU WANT TO SEE IT RIGHT AWAY.
AND YOU DON'T.
I HAD SO MUCH TO REBUILD JUST
PHYSICALLY, AND EMOTIONALLY
OBVIOUSLY FROM THE DISTANCE I
WAS PUTTING MYSELF FROM PEOPLE,
I JUST WANTED TO CRAWL IN BED
AND STAY THERE AND NOT GET BACK
UP.
BUT YOU HAVE TO TAKE THOSE BABY
STEPS TO GET OUT AND MAKE IT
BETTER, MAKE THE DAY COUNT IN
ONE WAY, EVEN IF IT'S JUST THE
LITTLEST THINGS LIKE FOLDING
YOUR LAUNDRY.
LIKE, THAT CAN JUST BE THE WIN
FOR THE DAY.
AND HOPE YOU GET TO THE NEXT.
THE MOST IMPACTFUL MOMENT I
PROBABLY HAD POST-CANCER TO HELP
ME EMOTIONALLY GET BETTER IS
JUST ALLOW MYSELF TO SEE MY
FAULTS, AND TO SEE THAT I DO
NEED HELP.
I WOULDN'T HAVE COME THIS FAR
WITHOUT A GREAT GROUP OF PEOPLE
AROUND ME.
NO MATTER HOW HARD I TRY TO PUSH
THEM AWAY, THEY WOULDN'T GO
AWAY.
SO JUST THE PEOPLE WHO ARE
AROUND YOU, NO ONE ELSE HAD
CANCER, NO ONE ELSE GOES THROUGH
IT, BUT THEY ALL GO THROUGH IT.
AND YOU'RE NEVER ALONE IN
TREATMENT, YOU'RE DEFINITELY NOT
ALONE AFTER.
WE NEED THE MOST HELP MAYBE,
THEY'RE ALWAYS THERE.
SOME ADVICE I WOULD GIVE A
SURVIVOR, GIVE YOURSELF
LENIENCY.
YOU HAVE TO GIVE YOURSELF THAT
ROOM TO GROW INTO THE NEW YOU.
>> IN THAT SHORT, SHORT 2-MINUTE
VIDEO, AND WE THANK MARK FOR
SHARING HIS STORY, YOU CAN SEE
HOW CANCER HAS AFFECTED MULTIPLE
QUALITY OF LIFE DOMAINS THAT ARE
CONSISTENT WITH THE CONCEPTUAL
MODEL THAT I HAD JUST SHARED
WITH YOU.
THE INNER SCARS, WHETHER THAT BE
ANXIETY, DEPRESSION, FEAR OF
RECURRENCE, THE SOCIAL ASPECT,
THE LIMITATIONS FUNCTIONALLY,
BEING UNABLE TO GO TO THE GYM
AND BE ON THE TREADMILL FOR VERY
LONG.
AND THEN FINDING NEW MEANING,
FINDING MEANING IN BEING ABLE TO
FOALT
BOLD THAT
FOLD THE LAUNDRY, SEEING THAT AS
A WIN AND GETTING THAT DONE, SO
CANCER DEFINITELY HAS MULTIPLE
AREAS OF WELL-BEING THAT WE MUST
ALWAYS CONSIDER.
IN DOING SO, AS I PROMISED, I
WILL SHARE WITH YOU SOME CURRENT
RESEARCH STUDIES THAT ARE IN THE
FIELD THAT ARE ADDRESSING THE
NEEDS OF CANCER SURVIVORS.
AND THEN I WILL CONCLUDE BY
TALKING SPECIFICALLY ABOUT
SOCIAL WELL-BEING AND OUR
NETWORK.
THIS FIRST STUDY IS LED AT THE
UNIVERSITY OF ALABAMA AT
BIRMINGHAM.
I'M ALSO A PART OF THIS STUDY AS
AB INVESTIGATOR AND LEADING SOME
OF THE RECRUITMENT AND RETENTION
ACTIVITIES.
THE NAME OF THE STUDY IS
ADAPTING MULTIPLE BEHAVIOR
INTERVENTIONS THAT EFFECTIVELY
IMPROVE CANCER SURVIVOR HEALTH.
ALSO KNOWN AS AMPLIFI.
SO WHAT IS AMPLIFI?
IT SEEKS TO TEST THE EFFECTS OF
THREE WEB-BASED DIET AND
EXERCISE INTERVENTIONS ON
BEHAVIOR CHANGE AND HEALTH
OUTCOMES.
ONE ARM WILL INVOLVE SIX MONTHS
OF DIET/WEIGHT-LOSS PROGRAM
FOLLOWED BY SIX-MONTH EXERCISE
PROGRAM.
THE SECOND ARM WILL BE SIX
MONTHS OF EXERCISE PROGRAM
FOLLOWED BY SIX-MONTH DIET AND
WEIGHT-LOSS PROGRAM.
THE THIRD ARM WILL BE 12 MONTHS
COMBINED, A PROGRAM OF BOTH DIET
AND WEIGHT LOSS AND EXERCISE AT
THE SAME TIME.
SO WHY IS THIS STUDY IMPORTANT?
WE KNOW THAT EXCESS BODY WEIGHT
IS ASSOCIATED WITH HIGHER RISK
FOR RECURRENCE, CO-MORBIDITY,
CANCER RELATED MORTALITY AND ALL
CAUSE MORTALITY.
WE ALSO KNOW THAT EXERCISE
DECREASES THE RISK OF SECOND
PRIMARY CANCERS, CO-MORBID IT,
REDUCE MORTALITY RISK AFTER A
CANCER DIAGNOSIS, AND DISTRESS
CAUSED BY POOR QUALITY OF LIFE,
FATIGUE, ANXIETY, AND
DEPRESSION.
THE STUDY IS ALSO IMPORTANT
BECAUSE WE KNOW THAT 52 TO EIGH%
OF CANCER SURVIVORS HAVE POOR
DIET QUALITY AND AN ESTIMATED
71% ARE OVERWEIGHT OR OBESE, AND
MANY CANCER SURVIVORS ARE
UNDERACTIVE.
SO THIS STUDY IS ENROLLING
INDIVIDUALS AGE 50-PLUS.
SO IF YOU ARE A CANCER SURVIVOR
OR KNOW OF ONE AND ARE
INTERESTED IN LOSING WEIGHT, WE
REALLY DO ENCOURAGE YOU TO REACH
OUT TO US.
SO THIS IS ADDRESSING THE
PHYSICAL DOMAIN OF QUALITY OF
LIFE.
THE NEXT STUDY THAT'S AN ONGOING
TRIAL IS ABOUT DR. SHELLEY JOHNS
AT INDIANA UNIVERSITY SCHOOL OF
MEDICINE, AND THAT IS TITLED
FACILITATING ADAPTIVE COPING
WITH FEAR OF RECURRENCE AMONG
BREAST CANCER SURVIVORS: A
THREE-ARM RANDOMIZED CONTROLLED
TRIAL.
SO WHAT DO WE KNOW?
WE KNOW FEAR OF CANCER
RECURRENCE, WHICH IS FEAR, WORRY
OR CONCERN, RELATING TO THE
POSSIBILITY THAT CANCER WILL
COME BACK OR PROGRESS, IS
PREVALENT.
IT'S A MILD AND TRANSIENT FORM
FEAR OF CANCER RECURRENCE IS
ALMOST UNIVERSAL, AND 40 TO 70%
OF SURVIVORS REPORT CLINICALLY
SIGNIFICANT FEAR OF CANCER
RECURRENCE.
WE ALSO KNOW IT'S DISRUPTIVE.
THERE ARE EXTENSIVE EVIDENCE
LINKS TO CLINICAL PROBLEMS
INCLUDING ANXIETY, DEPRESSION,
SLEEP DISTURBANCE, IMPAIRMENTS
IN FUNCTION AND REDUCED QUALITY
OF LIFE.
IT'S ALSO SIGNIFICANT BECAUSE
IT'S STABLE OVER TIME, EVEN WHEN
THE RISK OF RECURRENCE IS FELT.
FINALLY, FEAR OF CANCER
RECURRENCE IS THE MOST FREEPT
FREECTLY ENDORSED UNMET
SUPPORTIVE CARE NEED AMONG
SURVIVORS.
SO IF YOU ARE A SURVIVOR OF
BREAST CANCER AND LIVING IN
INDIANA, DR. JOHNS IS TESTING
THREE DIFFERENT APPROACHES TO
ADDRESSING FEAR OF RECURRENCE,
AND I DO ENCOURAGE YOU TO REACH
OUT TO HER AND HER TEAM.
THE FINAL STUDY, ONGOING STUDY
THAT I'LL SHARE WITH YOU IS AT
THE MEMORIAL SLOAN KETTERING
CANCER CENTER.
IT IS A PRAGMATIC RANDOMIZED
CONTROL TRIAL FOR HOMEBOUND
PALLIATIVE CARE PATIENTS.
WE KNOW PATIENTS WITH ADVANCED
CANCER ARE OFTEN CONFRONTED WITH
EXISTENTIAL DISTRESS THAT
CREATES ANXIETY AND DEPRESSION
AND WHEN UNADDRESSED LEADS TO
INCREASED SUFFERING AND DESPAIR.
WE ALSO KNOW THAT HOMEBOUND
INDIVIDUALS FACE COMPOUNDED
EX-IS TENSION CONCERNS AND LOSS
OF MEANING ABOVE AND BEYOND
AMBULATORY PATIENTS WITH
ADVANCED ILLNESSES, AS THEY MUST
CONTEND WITH AN EVEN GREATER
LOSS OF INDEPENDENCE AND
DECLINING OPPORTUNITIES FOR
ACTIVITIES AND SOCIAL
ENGAGEMENT.
AS THE DEMAND FOR DELIVERY OF
COMPREHENSIVE, HIGH QUALITY
PALLIATIVE CARE IN THE COMMUNITY
CONTINUES TO GROW, SO DOES THE
NEED TO ADDRESS THESE
UNDERSERVED PATIENTS.
MEANING CENTERED PSYCHOTHERAPY
IS AN EMPIRICALLY SUPPORTED
PSYCHOTHERAPEUTIC INTERVENTION
WITH CLINICALLY SIGNIFICANT
EFFICACY TO IMPROVING QUALITY OF
LIFE AND ALLEVIATING LOSS OF
MEANING, SPIRITUAL SUFFERING AND
DESPAIR.
SO THESE RESEARCHERS ARE SEEKING
TO EVALUATE THE ABILITY OF A
HOME CARE NURSE'S INTERVENTION
TO DELIVER THIS THERAPY TO
HOMEBOUND PATIENTS WITH ADVANCED
CANCER DIAGNOSIS.
IT'S A PARTNERSHIP WITH ACADEMIC
MEDICAL CENTER AND LARGE
COMMUNITY HOME BASED NETWORK IN
NEW YORK.
PRIMARY OUTCOMES WILL INCLUDE
FEASIBILITY, ACCEPTABILITY AND
PRELIMINARY EFFICACY OF NURSE
DELIVERED MCP TO THOSE THAT
WOULD OTHERWISE NOT HAVE ACCESS.
SO INDIVIDUALS WHO MAY QUALIFY
FOR THE STUDY, WE DO ENCOURAGE
YOU TO REACH OUT TO THE
PRINCIPAL INVESTIGATORS.
HERE IN THE NEW YORK AREA.
SO SO FAR, I'VE SHOWED YOU THE
QUALITY OF LIFE MODEL APPLIED TO
CANCER SURVIVORS, I'VE SHARED
WITH YOU THE AMPLIFI STUDY
THAT'S ADDRESSING PHYSICAL
WELL-BEING AND SYMPTOMS, THE
STUDY ADDRESSING SPECIFICALLY
FEAR OF RECURRENCE AND THE
NURSE-DELIVERED STUDY THAT'S
ADDRESSING SPIRITUAL WELL-BEING.
I WILL NOW TURN MY FOCUS TO
EMOT-ECON, AND THE REMAINDER OF
THE PRESENTATION WILL BE ABOUT
OUR NETWORK.
THE EMOTIONAL WELL-BEING NETWORK
IS A COLLABORATION AT THE
UNIVERSITY OF ALABAMA AT
BIRMINGHAM.
THE MISSION OF OUR NETWORK IS TO
DEVELOP CRITICAL KNOWLEDGE ABOUT
THE IMPACT OF ECONOMIC BURDEN OF
DISEASE ON EMOTIONAL WELL-BEING
OF PATIENTS AND FAMILIES WITH
THE ULTIMATE GOAL OF DEVELOPING
THE STRATEGIES NEEDED TO REDUCE
IT.
OUR MISSION IS TO BE THE PREMIER
GO-TO RESOURCE FOR RESEARCHERS
WHO SEEK TO ADVANCE AND SUPPORT
RESEARCH ON EMOTIONAL WELL-BEING
AND COMMISSION BURDEN, AND ITS
TRANSLATION INTO PUBLIC HEALTH
POLICY, PATIENT ADVOCACY AND
SUPPORT, AND INNOVATIONS IN
HEALTHCARE DELIVERY.
SO WHY IS OUR NETWORK NEEDED? IO
YOU A CONCEPTUAL FRAMEWORK ABOUT
THE ECONOMIC BURDEN OF CANCER.
AND THIS COMES FROM A REVIEW
PAPER BY DR. PISU AND
COLLEAGUES.
AS SEEN FROM THIS SLIDE, WHEN WE
THINK ABOUT THE ECONOMIC BURDEN
OF CANCER, THERE ARE TOLEDO E
DOMAINS.
WE HAVE DIRECT HEALTHCARE COSTS,
WE HAVE DIRECT MEDICAL
HEALTHCARE COSTS.
SO FOR EXAMPLE, AMOUNT OF MONEY
A PATIENT WOULD PAY TO A
HEALTHCARE PROVIDER, A
HEALTHCARE SYSTEM FOR CARE.
WE ALSO HAVE NON-MEDICAL COSTS,
SO FOR EXAMPLE, RESOURCES NEEDED
TO GET YOU TO THAT MEDICAL CARE,
SUCH AS TRANSPORTATION, AND THE
COST ASSOCIATED WITH YOUR TIME
RECEIVING THAT HEALTHCARE.
WE ALSO HAVE INDIRECT COST,
WHICH WE THINK OF AS
PRODUCTIVITY LOSS.
SO FOR INSTANCE, SOMEBODY WHO
HAS REDUCED THE AMOUNT OF TIME
THAT THEY WORK OR EVEN MAYBE
COME OUT OF THE WORKING
ENVIRONMENT ENTIRELY.
AND THEN WE HAVE PSYCHOSOCIAL
COSTS, THE QUALITY OF LIFE
LOSSES THAT ARE A CONSEQUENCE OF
THE ECONOMIC BURDEN OF CANCER.
THE RESEARCH HIGHLIGHTS THAM THE
FINANCIAL BURDEN ON INDIVIDUALS
SECONDARY TO ILLNESS IS
PROFOUND.
ON THIS SLIDE, I'M GOING TO
HIGHLIGHT JUST A FEW PAPERS THAT
HAVE EXAMINED THIS ISSUE.
THIS FIRST PAPER THAT APPEARED
IN THE JOURNAL OF CLINICAL
ONCOLOGY BY DR. RAMSEY AND
COLLEAGUES FOUND THAT
INDIVIDUALS WHO HAD A DIAGNOSIS
OF A CANCER AND THEN HAS
SUBSEQUENTLY DECLARED BANKRUPTCY
ARE MORE LIKELY TO DIE SOONER
THAN THEIR PEERS, WHO ALSO HAD
CANCER THAT DID NOT DECLARE
BANKRUPTCY.
THIS WAS A STUDY DONE IN
WASHINGTON STATE, THEY MATCHED
CANCER PATIENTS WHO HAD DECLARED
BANKRUPTCY WITH THOSE WHO HAD
NOT ON DEMOGRAPHIC AND CLINICAL
FACTORS.
AND THEN THEY ASKED THIS
QUESTION.
AGAIN, THEY FOUND THOSE WHO
FILED FOR BANKRUPTCY WERE AT
GREATER RISK TO EARLY MORTALITY.
THIS SPEAKS TO THE IMPORTANCE OF
TRYING TO UNDERSTAND THE
MECHANISMS BETWEEN FINANCIAL
BURDEN AND MORTALITY AND
SURVIVAL.
IMPORTANTLY FOR THIS STUDY IN
THOSE TWO GROUPS, CANCER
PATIENTS HAD RECEIVED SIMILAR
INITIAL TREATMENT SO IT DOES NOT
SEEM TO BE ACCOUNTED FOR BY
DIFFERENCES IN TREATMENT.
THIS NEXT PAPER, NATIONAL USED M
THE HEALTH AND RETIREMENT STUDY.
THEY FOUND THAT TWO YEARS AFTER
DIAGNOSIS, 42% OF CANCER
SURVIVORS HAD DEPLETED THEIR NET
WORTH AS WELL AS DECREASING DEBT
IN A NUMBER OF OTHER CATEGORIES
INCLUDING CONSUMER DEBT AS A
RESULT OF HAVING CANCER.
THIS NEXT PAPER, FANGS HARDSHIP
IN USED DATA FROM
THE NATIONAL INTERVIEW HEALTH
STUDY AND THEY LOOKED AT DATA
ACROSS AGE RANGES, SO YOUNGER
ADULTS AND OLDER ADULTS AND
FOUND THAT MEDICAL FINANCIAL
HARDSHIP WAS COMMON.
IN FACT, THEY HAD SOME VERY
IMPORTANT FINDINGS AS RELATES TO
EMOTIONAL HEALTH AND SO I'M
GOING TO TALK ABOUT THIS PAPER A
LITTLE BIT MORE IN THE NEXT FEW
SLIDES.
THIS NEXT PAPER CONDUCTED D
EXTENSIVE FINANCIAL HARDSHIP
AMONG GYNECOLOGICAL CANCER
PATIENTS STARTING A NEW LINE OF
THERAPY.
ACCORDING TO THE STUDY, 74% OF
THE PARTICIPANTS HAD PRIVATE
INSURANCE.
NONETHELESS, 54% REPORTED
FINANCIAL DISTRESS, AND THIS WAS
A MEASURE THAT ASKED QUESTIONS
SUCH AS, MY CANCER OR TREATMENT
HAS REDUCED MY SATISFACTION WITH
MY PRESENT FINANCIAL SITUATION.
I WORRY ABOUT THE FINANCIAL
PROBLEMS I WILL HAVE IN THE
FUTURE AS A RESULT OF MY ILLNESS
OR TREATMENT.
I FEEL I HAVE NO CHOICE ABOUT
THE AMOUNT OF MONEY I SPEND ON
CARE.
IN THIS NEXT PAPER WE DID A FEW
YEARS AGO, WE EXAMINED WHAT
PATIENTS WORRY ABOUT MAKING
DECISIONS, AND OUR STUDY FOUND
THAT 40% OF PATIENTS WITH CANCER
WHEN MAKING DECISIONS WORRIED
ABOUT THE COST OF CARE.
AND THIS IS IN A NATIONAL SAMPLE
OF OVER 5,000 CANCER SURVIVORS.
WE ALSO FOUND THAT THOSE WHO
PERCEIVED THEIR HEALTH AS LESS
THAN EXCELLENT AND THOSE WITH
MORE ADVANCED CANCER DIAGNOSIS
WERE MORE LIKELY TO WORRY AS
WELL.
AS PROMISED, I WANTED TO DIG A
LITTLE BIT DEEPER WITH ONE OF
THOSE PAPERS, AS I THINK IT IS
VERY TELLING WHEN WE THINK ABOUT
ONE'S EMOTIONAL HEALTH, AND THE
BURDEN OF CANCER.
IN THIS PAPER, THEY DEFINED
HARDSHIP IN THREE WAYS.
YOU HAD MATERIAL HARDSHIP,
PROBLEMS PAYING MEDICAL BILLS
AND/OR PAYING OFF MEDICAL BILLS,
YOU HAD PSYCHOLOGICAL HARDSHIP,
WORRY ABOUT PAYING COST OF
SERIOUS ILLNESS AND/OR NORMAL
HEALTHCARE, AND THERE IS
BEHAVIORAL HARDSHIP, DELAYING
AND/OR FOREGOING CARE DUE TO
WORRY ABOUT COST AND/OR BEING
UNABLE TO AFFORD NEEDED CARE.
IN THIS FIRST FIGURE FROM THE
TABLE, IT'S ANY MATERIAL,
PSYCHOLOGICAL OR BEHAVIORAL
MEDICAL FINANCIAL HARDSHIP BY
AGE GROUP.
AND THE AGE GROUP COMPARISONS
WERE ALL SIGNIFICANT.
INTERESTINGLY AS YOU SEE HERE,
THE HARDSHIP WAS REALLY GREATEST
IN THE PSYCHOLOGICAL REALM.
ESPECIALLY FOR THE YOUNGER
POPULATION.
NEXT FIGURE LOOKED AT THE
PERCENTAGE OF ANY MATERIAL
FINANCIAL HARDSHIP, THEY DID SO
BETTER BY AGE BUT BY INSURANCE
STATUS, WITH THE BLUE BEING ALSO
THE YOUNGER POPULATION.
INDICATING THE OLDER POPULATION.
SO AS YOU CAN SEE THE UNINSURED,
WHILE THEY DID HAVE THE HIGHEST
PERCENTAGE OF ANY MATERIAL
FINANCIAL HARDSHIP, THERE WAS
HARDSHIP ACROSS ALL TYPES OF
INSURANCE STATUS.
NEXT SLIDE AGAIN PRESENTS THE
DATA BY INSURANCE STATUS, AND IT
EXAMINES PSYCHOLOGICAL HARDSHIP.
AND AS YOU CAN SEE, AMONG THE
UNINSURED, ON THE LEFT SIDE OF
THIS SLIDE, 71% HAD
PSYCHOLOGICAL CONCERNS AS
RELATED TO THEIR FINANCES.
EVEN THOSE AMONG PRIVATE AND
PUBLIC ONLY INSURANCE SIMILARLY
HAD HIGH RATES OF PSYCHOLOGICAL
DISTRESS.
THIS LAST ONE IS BEHAVIORAL
HARDSHIP.
AND AGAIN, YOU'LL SEE SIMILAR
PATTERNS OF THOSE WHO ARE
UNINSURED, HAVING HIGHER RATES
THAT THOSE WHO DO HAVE INSURANCE
ARE STILL PRESENTING WITH
CONCERNS RELATED TO THIS TOPIC.
SO THE ECONOMIC BURDEN OF
DISEASE IMPACTS ONE'S EMOTIONAL
HEALTH.
QUESTIONS REMAIN, AT LEAST FOR
US, THEY DID.
WE WERE CURIOUS, WHAT ARE THE
CORE COMPONENTS OF EMOTIONAL
WELL-BEING, ESPECIALLY IN THIS
CONTEXT OF ECONOMIC BURDEN OF
DISEASE.
AND HOW IS EMOTIONAL WELL-BEING
DIFFERENT FROM WORRY,
PSYCHOLOGICAL HARDSHIP,
FINANCIAL DISTRESS, QUALITY OF
LIFE.
YOU'VE PROBABLY NOTICED THAT IN
MY EARLIER COMMENTS AND AS I
TALKED ABOUT STUDIES, DIFFERENT
TERMS WERE USED.
ARE WE TALKING ABOUT THE SAME
THING OR ARE THEY CONCEPTUALLY
DISTINCT?
SPECIFICALLY ARE THEY
CONCEPTUALLY DISTINCT FROM
EMOTIONAL WELL-BEING.
WHAT LINKS FINANCIAL BURDEN WITH
HEALTH OUTCOMES?
AND CAN WE PREVENT THE HARMFUL
EFFECTS OF ECONOMIC BURDEN ON
ONE'S EMOTIONAL WELL-BEING?
SO TO ANSWER THOSE QUESTIONS,
DR. PISU AND I REALLY THOUGHT
ABOUT IT AND PUT TOGETHER THE
GRANT AND RESPONSE TO THE
FUNDING OPPORTUNITY, AND WE'RE
SO GRATEFUL TO BE FUNDED TO
ESTABLISH THIS NETWORK.
WE PLAN TO BE ABLE TO ANSWER
THOSE QUESTIONS AND MORE BY
PURSUING THREE AIMS.
OUR FIRST AIM IS TO ESTABLISH A
MULTIDISCIPLINARY NETWORK OF
RESEARCHERS, PATIENTS,
CAREGIVERS, HEALTHCARE
PROVIDERS, AND OTHERS,
INTERESTED IN THE TOPIC AND
INTERESTED IN ADVANCING THE
FIELD.
IT WAS VERY, VERY IMPORTANT TO
US THAT WE BROUGHT MANY
INDIVIDUALS TO THE TABLE THAT
CAME WITH DIFFERENT PERSPECTIVES
AND DIFFERENT EXPERIENCES.
ESPECIALLY PATIENTS AND
CAREGIVERS WHO ARE AFFECTED BY
THE ECONOMIC BURDEN OF DISEASE.
AND WHILE OUR WORK PRIMARILY HAS
BEEN DONE IN CANCER AND WHILE
THE ECONOMIC BURDEN OF DISEASE
TO DATE HAS BEEN PRIMARILY DONE
IN CANCER, THIS NETWORK IS
INTERESTED IN UNDERSTANDING THE
DISEASE BURDEN ACROSS MANY
DISEASES.
ECONOMIC BURDEN.
THE SECOND AIM IS TO IMPLEMENT A
PILOT PROJECT PROGRAM OPEN TO
INVESTIGATORS ACROSS THE
COUNTRY.
AND SO WE'RE REALLY EXCITE TODAY
HAVE THE OPPORTUNITY TO ADVANCE
RESEARCHERS IN A VERY TANGIBLE
WAY WITH PROJECTS IN THIS AREA.
AND OUR THIRD AIM IS TO DEVELOP
AND TO SHARE RESOURCES.
SO WE'VE RECENTLY LAUNCHED A
SEMINAR SERIES THAT ALLOWS
INDIVIDUALS TO ATTEND VIRTUALLY
TO LEARN ABOUT THE ECONOMIC
BURDEN OF TEASE DISEASE AND L
WELL-BEING.
WE HAVE A WEBSITE THAT INCLUDES
A SEARCHABLE LITERATURE DATABASE
ON TOPICS THAT ARE RELEVANT TO
THE NETWORK.
WE HOPE TO HAVE A REPOSITORY OF
MEASUREMENT TOOLS, AND WE'RE
ABOUT TO LAUNCH A FIND A
COLLABORATOR FUNCTION, WHERE IN
IF THERE'S A HEALTHCARE PROVIDER
OR A PATIENT OR INVESTIGATOR WHO
WANTS TO WORK IN THIS AREA BUT
DOES NOT KNOW WHO TO WORK WITH,
WE CAN TRY TO DO SOME
MATCHMAKING.
WE'LL ALSO HAVE SCIENTIFIC
MEETINGS.
SO WE ALSO FELT IT IMPORTANT TO
FOCUS ON THREE AREAS FOR OUR
NETWORK.
OUR FIRST AREA OF FOCUS IS ON
ONTOLOGY AND MEASUREMENT OF
EMOTIONAL WELL-BEING, TO REALLY
TRY TO UNDERSTAND WHAT ARE THOSE
CORE COMPONENTS OF EMOTIONAL
WELL-BEING, PARTICULARLY IN THE
CONTEXT OF ECONOMIC BURDEN OF
DISEASE, AND HOW SHOULD WE
MEASURE IT.
WE'RE ALSO VERY INTERESTED IN
PRIORITIZING MECHANISTIC
RESEARCH ON THE ROLE OF
EMOTIONAL WELL-BEING IN HEALTH.
SO HOW DO WE CONNECT THE DOTS,
HOW DOES EMOTIONAL WELL-BEING
PROMOTE GOOD HEALTH OUTCOMES,
AND WHAT ROLE DOES ECONOMIC
BURDEN OF DISEASE PLAY IN THOSE
RELATIONSHIPS.
VERY IMPORTANT TO US, PREVENTION
RESEARCH.
IF WE COULD DECREASE THE BURDEN,
THE ECONOMIC BURDEN OF DISEASE
IN TERMS OF ONE'S EMOTIONAL
WELL-BEING, WE WOULD BE THRILLED
TO BE ABLE TO ADVANCE RESEARCH
IN THIS WAY.
SO WE BEGAN OUR JOURNEY WITH THE
DEFINITION PROVIDED BY THE
INSTITUTE AND IN THE FUNDING
OPPORTUNITY, AND DEFINING
EMOTIONAL WELL-BEING AS AN
OVERALL POSITIVE STATE OF ONE'S
EMOTIONS, LIFE SATISFACTION,
SENSE OF MEANING AND PURPOSE,
AND ABILITY TO PURSUE DEFINED
GOALS.
SINCE FUNDING, WE'VE HL THE
GREAT OPPORTUNITY TO WORK WITH
THE OTHER NETWORKS THAT HAVE
BEEN FUNDED TO REALLY THINK
ABOUT HOW WE MIGHT REFINE THIS
DEFINITION AND HOPEFULLY WE'LL
BE SHARING THAT WITH YOU MORE
BROADLY SOON.
OUR WORK IS ALSO GUIDED BY A
CONCEPTUAL FRAMEWORK, BUILDING
ON THE LAZARUS MODEL OF STRESS
APPRAISAL AND COPING AND SOME OF
OUR EMOTIONAL -- HAS BEEN
INFORMED BY SOME WORK BY
DR. HEAD WHO WROTE A PAPER, AS
IF THE DISEASE WAS NOT ENOUGH,
COPING WITH THE FINANCIAL
CONSEQUENCES OF CANCER.
SO WE'LL TAKE A MOMENT TO SPEND
SOME TIME HERE AND GO THROUGH
THIS FRAMEWORK, AND IT'S OUR
HOPE THAT OF THE NETWORK THAT
THE RESEARCH WE GENERATE REALLY
COULD REFINE THIS FRAMEWORK AND
HE
MAYBE ADD TO IT AND EXPAND TO IT
IN IMPORTANT WAYS.
SO THINK ABOUT THE ECONOMIC
BURDEN OF DISEASE AS A POTENTIAL
STRESSOR, SO ON THE LEFT-HAND
SIDE WITH THE RED CIRCLE IS
WHERE WE WOULD PLACE THE
ECONOMIC BURDEN OF DISEASE.
AND WE ANTICIPATE THAT
INDIVIDUALS FIRST ENGAGE IN A
PRIMARY APPRAISAL OF THAT
BURDEN, SO IS THAT BURDEN
RELEVANT TO ME, IS IT STRESSFUL,
DO I HAVE THE RESOURCES TO
ADDRESS IT.
AND WE REALLY WANT TO UNDERSTAND
WHAT FACTORS INFLUENCE THAT
PRIMARY APPRAISAL.
SO THE FACT IS, WE'VE STARTED
WITH, AS OUR BEGINNING WORKING
MODEL, INCLUDES HEALTH, SO ONE'S
SELF-PERCEIVED HEALTH, MAYBE
OTHER COMORBIDITIES, MIGHT
INFLUENCE WHETHER OR NOT YOU SEE
THIS ECONOMIC BURDEN OF DISEASE
AS SOMETHING THAT IS STRESSFUL.
DEMOGRAPHIC VARIABLES SUCH AS
YOUR AGE, RACE/ETHNICITY AND
GENDER, SOCIAL VARIABLES SUCH AS
ONE'S SOCIAL SUPPORT NETWORK,
THE SIZE OF THE NETWORK MIGHT
INFLUENCE WHETHER OR NOT YOU SEE
THAT ECONOMIC BURDEN AS
STRESSFUL.
SOCIOECONOMIC FACTORS SUCH AS
EDUCATION, YOUR INCOME AND
SAVINGS, THE NUMBER OF
INDIVIDUALS THAT YOU SUPPORT
WITH YOUR INCOME, YOUR HEALTH
INSURANCE.
AND PSYCH LOGIC CONSIDERATIONS
SUCH AS STIGMA, WHETHER IT BE
STIGMA RELATED TO YOUR DISEASE
OR STIGMA RELATED TO FEELING
THAT YOU'RE UNABLE TO AFFORD THE
CARE THAT YOU DESIRE.
FINANCIAL DISTRESS, YOUR WORRY,
ABILITY TO DEAL WITH
UNCERTAINTY, VALUES AND BELIEFS
AND SHAME.
ALL THESE VARIABLES REALLY NEED
TO BE STUDIED TO SEE WHAT ROLE
THEY PLAY, IF ANY, IN ONE'S
PRIMARY APPRAISAL.
OUR SECOND AREA OF APPRAISAL
REALLY INVOLVES THINKING ABOUT
WHAT ONE WILL DO WITH THE
PROBLEM OF ECONOMIC BURDEN.
AND WE CONCEPTIZED IT AS EMOTION
FOCUSED COPING AND PROBLEM
FOCUSED COPING.
EMOTION FOCUSED COPING INCLUDES
A VARIETY OF WHAT INDIVIDUALS
MIGHT DO AND A LOT OF WHAT WE
HAVE IN THIS BOX CAME FROM THAT
HEAD MODEL IN WHICH THEY DID A
QUALITATIVE INTERVIEW WITH
CANCER SURVIVORS.
SO WHILE YOU HAD THIS ECONOMIC
BURDEN OF DISEASE, YOU MIGHT
ALSO STILL BE VERY GRATEFUL FOR
ALL THE OTHER THINGS YOU MAY
HAVE IN YOUR LIFE.
SO YOU RELY ON YOUR PERSONAL
STRENGTHS.
DECIDE TO BE DETERMINED SO YOU
FIGHT BACK.
OR YOU MAY BE FRUSTRATED.
YOU MAY TAKE CARE OF -- RELYING
ON YOUR RELIGION OR SPIRITUAL
BELIEFS, YOU MAY SEEK OUT
ACCESSING SOCIAL SUPPORT.
YOU MAY ALSO ENGAGE IN
PROBLEM-FOCUSED COPING, SO HOW
AM I GOING TO COPE OR DEAL WITH
THIS PROBLEM OF THIS BILL I
DIDN'T EXPECT TO RECEIVE?
YOU MAY BEGIN TO MAKE CHANGES OR
SACRIFICES SO YOU MAY DELAY OR
FOREGO CARE.
YOU MAY PUT OFF RETIREMENT, YOU
MAY MAKE FINANCIAL ADJUSTMENTS,
USING UP SAVINGS, -- MAY SEEK OR
ACCESSORY SOURCES JUST AS THOSE
FINANCIAL ASSISTANCE IN DEALING
WITH INSURANCE.
SO WE ARE CURIOUS AND WE WILL
STUDY AND EXPLORE HOPEFULLY WITH
OUR PILOT PROGRAM WHAT TYPES OF
SECONDARY APPRAISALS AND COPING
DO INDIVIDUALS ENGAGE IN, AND
HOW MIGHT THAT COPING LEAD TO
EMOTIONAL WELL-BEING, AND HOW
DOES EMOTIONAL WELL-BEING,
IMPORTANTLY, LEAD TO QUALITY OF
LIFE AND HEALTH OUTCOMES?
WHAT ARE THE UNDERLYING
PSYCHOSOCIAL PATTERNS.
SO WORK IS BEGINNING TO BE DONE
IN THIS AREA, AND I WANTED TO
SHARE THIS PAIM WITH YOU THAT
EXAMINED THE RACIAL DIFFERENCES
IN EMPLOYMENT AND COST
MANAGEMENT BEHAVIORS IN PATIENTS
WITH METASTATIC BREAST CANCER.
SO IN THIS STUDY, THEY HAD A
DIVERSE SAMPLE OF WOMEN WITH
BREAST CANCER.
THEY COMPLETED AN ONLINE SURVEY,
ALL HAD METASTATIC BREAST
CANCER.
AND THIS GRAPH SHOWS SOME OF
THEIR CHANGES IN WORK FOR PAY BY
RACE AND ETHNICITY.
THE FIRST BAR, THE WHITE,
REFLECTS THE NON-HISPANIC
WHITES.
THE SECOND BAR, NON-HISPANIC
BLACKS, THE THIRD BAR,
HISPANICS, THE FOURTH, ASIAN
PACIFIC ISLANDERS, AND THE LAST,
AMERICAN INDIANS.
AND AS YOU CAN SEE, THERE'S
GREAT DIVERSITY WITH RESPECT TO
THE CHANGES IN WORK, BOTH IN
TERMS OF WHAT INDIVIDUALS HAD TO
DO, STOPPED WORKING, REDUCE
HOURS, TOOK PAID LEAVE, TOOK
UNPAID LEAVE, RETIRED, OR
CHANGED JOBS.
THE NEXT SLIDE SPEAKS TO THE
COST MANAGEMENT BEHAVIORS BY
RACE.
AS YOU CAN SEE, AGAIN THERE'S
GREAT VARIABILITY TO WHAT
INDIVIDUALS WERE DOING.
STIPPING SKIPPING OR REFUSIN,
USE SAVINGS, FILE FOR
DISABILITY, SKIPPED OVER MEDICAL
BILLS, SKIPPED NON-MEDICAL
BILLS, APPLIED FOR FINANCIAL
ASSISTANCE, RECEIVED FINANCIAL
ASSISTANCE.
>> YOU HAVE ABOUT FIVE MINUTES,
MICHELLE.
THANK YOU.
>> THANK YOU.
AND AS YOU CAN SEE, WHEN YOU
THINK ABOUT INDIVIDUALS HAVING
TO ENGAGE IN ALL OF THESE
DIFFERENT BEHAVIORS, WHAT IMPACT
MIGHT THAT HAVE ON ONE'S
EMOTIONAL WELL-BEING?
THESE DATA I'M PRESENTING YOU
NOW ARE UNADJUSTED ODDS.
WHEN THEY DID ADJUST FOR
SOCIODEMOGRAPHIC AND CLINICAL
FACTORS, THEY DID CONTINUE TO
FIND RACIAL AND ETHNIC
DIFFERENCES.
SO FOR EXAMPLE, NON-HISPANIC
BLACKS AN ASIAN PACIFIC
ISLANDERS WHEN COMPARED TO
WHITES WERE MORE LIKELY TO
REFUSE TREATMENT OR STOP
TREATMENT.
AS A RESULT OF THE COST
ASSOCIATED WITH THEIR CANCER
TREATMENT.
SO THAT'S JUST A QUICK
INTRODUCTION TO THE EMOT-ECON
RESEARCH NETWORK.
WE HOPE YOU WILL JOIN US ON THIS
JOURNEY.
WE HAVE A TWITTER HANDLE AT EMO
UNDERSCORE ECON.
WE ALSO HAVE A WEBPAGE AND WE
HOPE YOU JOIN EMOT-ECON.
JOINING EMOT-ECON MAKES YOU
ELIGIBLE FOR THE PILOT PROJECTS
AND YOU ALSO HAVE ACCESS TO OUR
ARCHIVED SEMINARS THAT WE ARE
RECORDING.
SO AS I PROMISED TO CONCLUDE
WITH SOME REFLECTIONS, WHEN I
THINK ABOUT PATIENTS WITH A
HISTORY OF CANCER AND I THINK
ABOUT THIS PRESENTATION, I'M
REMINDED OF THE IMPORTANCE OF
CONSIDERING THE WHOLE PERSON.
ALWAYS GOING BACK TO THAT
QUALITY OF LIFE MODEL IN WHICH
WELL-BEING REALLY IS ACROSS
MULTIPLE DOMAINS.
AND WHEN YOU THINK ABOUT THE
WHOLE PERSON, YOU ALWAYS WANT TO
KNOW OR THINK ABOUT OR CONSIDER
WHAT ROLE DO HEALTHCARE
PROVERS PLAY, DO
POLICY MAKERS PLAY, AND HOW CAN
WE ALL COME TOGETHER TO ADDRESS
THE NEEDS OF SURVIVORS?
SO FOR EXAMPLE, A PROJECT BY DRD
WITH PATIENTS AS WELL AS CANCER
CENTER STAFF TO TALK ABOUT THE
COST OF CARE CONVERSATIONS.
AND PATIENTS ACTUALLY WANT TO
TALK ABOUT COST BUT THEY WANT TO
DO SO AT A CERTAIN TIME, NOT AS
SOON AS THEY GET DIAGNOSED, BUT
BEFORE TREATMENT BEGINS AND THEY
WANT THAT INDIVIDUAL HAVING THAT
CONVERSATION WITH THEM TO BE
COMPASSIONATE AND CARING.
SO WHEN YOU THINK ABOUT AN
INTERVENTION SUCH AS LIKE HOW WE
STRUCTURE THOSE COST
CONVERSATION, ONE CAN SEE THAT
IT PROBABLY HAS A ROLE AND CAN
IMPACT ONE'S EMOTIONAL HEALTH AS
THEY GO THROUGH THE JOURNEY.
HOW DO WE DEVELOP INTERVENTIONS
THAT HONOR THE WHOLE PERSON?
I THINK THIS IS ONE OF THE HARD
ONES.
I THINK AS RESEARCHER, WE STUDY
DIFFERENT PARTS OF THE PUZZLE.
THE PATIENTS REALLY ARE WHOLE
PEOPLE AND THEY ACTUALLY WANT A
MORE HOLISTIC, WHOLE APPROACH TO
OUR WORK.
WHAT DOES WELL-BEING REALLY
MEAN?
IS IT WELL-BEING WITH THE NEW
NORMAL?
THAT TERM IS OFTEN USED WITH
CANCER SURVIVORS THAT THIS IS
THE NEW NORMAL, SO WHAT DOES
THAT MEAN UNDER THOSE
CIRCUMSTANCES TO BE WELL?
AND AS WE ADVANCE THE SCIENCE OF
EMOTIONAL WELL-BEING, DHOW WE
DETERMINE WHAT IS A E
DETERMINE WHAT IS A HEALTHY
LEVEL OF EMOTIONAL WELL-BEING?
I HAVE MANY ACKNOWLEDGMENTS THAT
I WOULD LIKE TO ACKNOWLEDGE AND
THANK, SO THANK YOU FOR THE
OPPORTUNITY TO BE A PART OF THE
SPRING 2022 SEASON OF
INTEGRATIVE MEDICINE RESEARCH
LECTURE SERIES.
I'D LIKE TO ACKNOWLEDGE AND
THANK PARTICIPANTS OF RESEARCH
STUDIES WHO INVITED US INTO
THEIR LIVES IN ORDER TO BE ABLE
TO ASK QUESTIONS AND UNDERSTAND
THEIR EXPERIENCES AND HOPEFULLY
COME UP WITH INTERVENTIONS AND
PROGRAMS TO ELEVATE THE HEALTH
AND WELL-BEING OF EVERYONE.
I'D LIKE TO THANK THE PRINCIPAL
INVESTIGATORS OF THE ONGOING
STUDYS THAT ALLOWED ME TO
HIGHLIGHT THEIR STUDY IN MY
PRESENTATION TODAY, PROVIDED
CONTENT FOR THOSE SLIDES.
I'D ALSO LIKE TO ACKNOWLEDGE THE
EMOT-ECON TEAM, DR. MARIA PISU,
KOAS INVESTIGATORS, STEERING
COMMITTEE MEMBERS AND PROGRAM
OFFICIAL NETWORK.
AND I WELCOME ANY QUESTIONS.
THANK YOU FOR YOUR ATTENTION
TODAY.
>> WELL, THANK YOU, DR. MARTIN.
THAT WAS REALLY AN INTERESTING
TALK, AND IT'S FASCINATING TO
SEE HOW YOU'RE LAUNCHING THIS
NETWORK AND THE PILOT PROGRAMS.
WE'RE GOING TO MOVE NOW TO OUR Q
& A SESSION.
AND I ENCOURAGE ANY VIEWERS WHO
ARE WATCHING ON VIDEOCAST OR ON
FACEBOOK LIVE TO SHARE YOUR
QUESTIONS WITH US.
YOU CAN EITHER USE THE NIH
VIDEOCAST FEEDBACK FORM OR PUT
ANY COMMENTS YOU HAVE INTO THE
FACEBOOK LIVE, YOU CAN POST A
COMMENT THERE OR QUESTION.
SO DR. SHURTLEFF, I'M GOING TO
TURN TO YOU TO KICK OFF THIS Q &
A SESSION.
ARE THERE ANY QUESTIONS YOU WANT
TO BEGIN WITH FOR DR. MARTIN?
>> DR. MARTIN, THAT WAS A GREAT
TALK.
THANK YOU SO MUCH FOR
PRESENTING.
IT'S SUCH IMPORTANT WORK WHEN
YOU THINK ABOUT CANCER SURVIVORS
AND THE STRESS THEY FACE, AND I
REALLY APPRECIATED THE
TESTIMONIAL FROM MARK AS A
PATIENT SHOWING REALLY WHAT IT'S
LIKE TO GO THROUGH SUCH AN
ORDEAL.
I WAS CURIOUS, I APPRECIATE THE
IDEA OF THIS COPING STRATEGY, I
THINK IT'S SO IMPORTANT AND
YOU'VE BROUGHT IT UP SO
ELOQUENTLY.
I'M WONDERING, THOUGH, WHEN I
THINK ABOUT RESILIENCE AND IN
THAT CONTEXT OF RESILIENCE, THE
IDEA OF RESISTING A CHALLENGE,
SO MAYBE PREPARING INDIVIDUALS
PRIOR TO A SIGNIFICANT LIFE
EVENT LIKE CANCER, ARE THERE
THINGS YOU CAN THINK ABOUT
BEFORE AN INDIVIDUAL FACES A
MAJOR LIFE EVENT LIKE CANCER,
WAYS OF STRENGTHENING
RESILIENCE, WAY OF CONCEPTIZING
OR THINKING ABOUT STRATEGIES
THAT THEY MIGHT USE OR BE
KNOWLEDGEABLE ABOUT PRIOR TO THE
SORT OF EVENTS WE CAN SORT OF
PREPARE THEM FOR?
HAVE YOU THOUGHT ABOUT THAT?
CERTAINLY AS THEY GET INTO THESE
SITUATIONS, THEY NEED TO COPE,
BUT ARE THERE OTHER WAYS WE
COULD MAYBE INTERVENE SOONER,
EITHER SYSTEMICALLY THROUGH
STRUCTURALNG
ENVIRONMENTAL, EDUCATIONAL
INTERVENTIONS OR OTHER WAYS WE
MIGHT DO SOMETHING PRIOR TO THE
STRESSFUL EVENT?
JUST A THOUGHT.
>> THANK YOU FOR THAT QUESTION.
THAT'S A GREAT QUESTION AND ONE
THAT I HAD NOT REALLY THOUGHT.
SO IT'S REALLY AN INTERESTING
WAY OF KIND OF CONCEPTUALIZING
HOW WE MIGHT SUPPORT PATIENTS
BETTER BY PREPARING THEM PRIOR
TO THE EVENT HAPPENING.
SO I WOULD HAVE TO GIVE THAT A
LOT OF THOUGHT, AND THERE ARE A
COUPLE THINGS I'M KIND OF
STRUGGLING IN MY MIND RIGHT NOW
AS I THINK ABOUT IT.
SO WHEN I THINK ABOUT IT FROM A
HEALTH BEHAVIOR PERSPECTIVE, I
THINK ONE OF THE THINGS WE'VE
TRIED DO IS, YOU KNOW, LET'S SAY
ENCOURAGE PHYSICAL ACTIVITY OR
HEALTHY EATING FOR SOME EVENT
THAT IS SO DISTAL.
AND I THINK THAT WE'RE LEARNING
THAT WE NEED TO BE ABLE TO
CONNECT TO SOMETHING THAT IS
SORT OF MORE IN THE HERE AND NO
TO REALLY MOTIVATE INDIVIDUALS
TO MAKE THOSE CHANGES.
SO SIMILARLY, I WONDER HOW WE
MIGHT CRAFT -- LET'S BE
RESILIENT FOR SOMETHING THAT MAY
HAPPEN IN THE FUTURE, SO I'M NOT
EXACTLY SURE, BUT THERE'S GOING
TO GIVE ME SOMETHING TO THINK
ABOUT THIS AFTERNOON FOR SURE.
I MEAN, THAT'S REALLY
INTERESTING.
BUT I THINK THE OTHER THING I
THINK ABOUT AS A PSYCHOLOGIST IS
LIKE, YOU WANT THAT HEALTHY
COPING BUT WE ALSO WANT
INDIVIDUALS TO EXPERIENCE THE
FULL RANGE OF EMOTIONS.
I THINK THAT'S ONE OF THE THINGS
WE'VE STRUGGLED WITH WHEN WE
THINK ABOUT EMOTIONAL
WELL-BEING, WHEN SOMETHING SAD
HAPPEN, YOU TRULY WANT THEM TO
EXPERIENCE THAT GRIEF AND THAT
SADNESS AND THAT SORT OF AN
APPROPRIATE EMOTION DURING THAT
TIME.
AND SO HOW DO WE BALANCE HELPING
INDIVIDUALS EXPERIENCE FULLY BUT
MAYBE NOT STAYING IN THAT SPACE
SO LONG THAT IT MAYBE DISRUPTS
OTHER AREAS OF THEIR LIFE.
SO IT'S INTERESTING WHEN YOU
THINK ABOUT RESILIENCE AND WHAT
THAT MEANS, WHAT THAT MEANS IN
DIFFERENT CONTEXTS.
THANK YOU FOR THAT QUESTION.
>> DO YOU HAVE ANY OTHER
QUESTIONS, DAVID, OR WE CAN MOVE
TO A QUESTION FROM OUR AUDIENCE.
>> PLEASE GO AHEAD.
>> ONE OF OUR AUDIENCE MEMBERS
ASKS DR. MARTIN FOR YOUR
RESEARCH, DID YOU HAVE AN
OPERATIONAL DEFINITION OF
SPIRITUALITY OR SPIRITUAL
HEALTH?
AND I KNOW YOU TALKED A LITTLE
BIT ABOUT DEFINITIONS, SO I
THINK THIS IS SOMEBODY WANTING
TO FOCUS IN ON SPIRITUALITY AND
SPIRITUAL HEALTH ITSELF.
ANY THOUGHTS YOU CAN SHARE?
>> SO I DID NOT HAVE A
DEFINITION FOR SPIRITUALITY, AND
I MIGHT MAYBE CONNECT THE
INDIVIDUALS THAT I KNOW SPEND
MORE OF THEIR TIME IN THAT AREA
OF RESEARCH, BUT IT'S VERY
IMPORTANT AS WE MOVE FORWARD, WE
ALWAYS NEED TO HAVE THOSE VERY
CLEAR DEFINITIONS AND I WOULD
LOVE TO LEARN FROM THAT AUDIENCE
MEMBER HOW THEY CONCEPTUALIZE
SPIRITUALITY.
BECAUSE I THINK FOR SURE WE NEED
TO BE CLEAR ABOUT OUR
DEFINITIONS.
AND I THINK THERE'S -- IN THE
FIELD, PEOPLE HAVE BEEN
CHALLENGED WITH RELIGION VERSUS
SPIRITUALITY AND WHAT'S THE
DISTINCTION, AND THOSE ARE
COLLAR FIXES TO MAKE
CLARIFICATIONS WE NEED TO MAKE
FOR SURE.
>> SO WE HAD A QUESTION FROM A
COLLEAGUE, ONE OF OUR COLLEAGUES
SAYS, CAN YOU ELABORATE ON THE
FINDING FROM YOUR PAPER THAT
THERE WAS VARIATION ACROSS
RACIAL/ETHNIC FREUPS AND D
WORRYING ABOUT MAKING TREATMENT
DECISIONS.
SO CAN YOU ELABORATE ON THAT A
LITTLE BIT?
>> SURE.
SO DEPENDING ON THE OUTCOME WE
WERE THINKING ABOUT, THERE WERE
THOSE DIFFERENCES BY RACE AND
ETHNICITY, SO I'M TRYING TO
REMEMBER BECAUSE THERE WERE
SEVERAL OUTCOMES FOR THAT IN
ADDITION TO THE ECONOMIC BURDEN.
I DO KNOW THAT -- I'M SORRY, CAN
I GET BACK ON THAT QUESTION?
>> ABSOLUTELY.
WE CAN CERTAINLY COME BACK AND
CIRCLE BACK ON THAT ONE.
SO WE HAVE A QUESTION HERE FROM
ONE OF OUR AUDIENCE MEMBERS THAT
I THINK IS A GOOD ONE AND I
THINK YOU TOUCHED ON THIS A
LITTLE BIT.
AND THIS PERSON IS ASKING, ARE
PATIENTS AND PATIENT ADVOCATES
INVOLVED IN THE STUDY DESIGN
RECRUITMENT AND EVALUATION?
SO TO WHAT LEVEL DO YOU HAVE
PATIENT ADVOCATES AND OTHERS
ENGAGED IN THE STUDY DESIGN?
>> THANK YOU.
THAT'S A GREAT QUESTION.
SO OUR NETWORK IS GUIDED BY
STEERING COMMITTEE, MEMBERS FROM
ACROSS THE COUNTRY.
WE HAVE FOUR INDIVIDUALS WHO ARE
ACADEMIC RESEARCHERS AND WE HAVE
FIVE INDIVIDUALS WHO ARE PATIENT
ADVOCATES, PATIENTS THEMSELVES,
PROVIDING -- INDIVIDUALS PROVIDE
CARE IN UNDERSERVED COMMUNITIES.
AND SO THEREFORE IT'S DEFINITELY
AT THE TABLE.
AND WE WOULDN'T DO IT ANY OTHER
WAY FOR SURE.
FOR SURE.
AND THE STEERING COMMITTEE TRULY
DOES PROVIDE US GUIDANCE ON THE
PRIORITIES OF THE NETWORK,
THINKING ABOUT THE PRIORITIES OF
THE PILOT PROJECTS AND THEY HELP
US PLAN OUR SCIENTIFIC MEETINGS.
>> THAT'S GREAT.
WE'VE HAD A COUPLE OF QUESTIONS
THAT ARE COMING IN SORT OF ABOUT
WHAT ERK CYSTS EXISTS IN TE
FINANCIAL ASSISTANCE TO HELP
PATIENTS DEAL WITH THE SHORT
TERM AND LONG TERM ECONOMIC
BURDENS, EITHER WITH LOCALIZED
OR ADVANCED STAGE CANCER.
ARE THERE ANY THINGS THAT PEOPLE
NEED TO BE AWARE OF THAT ARE
CONCRETELY AVAILABLE THAT YOU'RE
AWARE OF THAT YOUR RESEARCH TEAM
IS AWARE OF?
>> YES, SO THERE ARE FOUNDATIONS
OF
TO HELP INDIVIDUALS NAVIGATE
THAT JOURNEY.
I'LL BE HAPPY TO SHARE SOME OF
THOSE FOUNDATIONS, MAYBE I CAN
SEND IT AND YOU CAN SHARE IT
WITH THE INDIVIDUALS THAT HAD
THE QUESTIONS.
AS WELL AS CANCER CENTER, A LOT
OF THEM NOW ARE PILOTING
FINANCIAL NAVIGATORS TO HELP
INDIVIDUALS NAVIGATE THAT ASPECT
OF CARE.
SO AT CANCER CENTERS, IT'S
REALLY BEEN A PRIORITY AS WELL,
SO THERE'S FINANCIAL ASSISTANCE
NAVIGATORS.
>> RIGHT.
RIGHT.
THAT'S REALLY GOOD TO KNOW.
AND YES, DEFINITELY WE CAN TOUCH
BASE AFTERWARD AND GATHER THAT
INFORMATION TO SHARE WITH THIS
PARTICULAR AUDIENCE MEMBER WHO
ASKED THIS QUESTION.
DAVID, DID YOU HAVE ANY OTHER
FOLLOW-UP QUESTIONS?
>> ACTUALLY I HAD ONE OTHER
THAT'S SORT OF RELATED.
FINANCIAL BURDEN COMES UP AS AN
IMPORTANT STRESSOR.
I WAS WONDERING, THERE ARE
SINGLE PAYOR SYSTEMS SUCH AS THE
VA, FOR EXAMPLE, THE DEPARTMENT
OF HEALTH, DOD, HEALTH SERVICES,
AND OTHER COUNTRIES, CANADA
COMES TO MIND WHERE M MEDICAL
CAROL IS COVERED BY THE STATE OR
IN THIS CASE VA OR SOME OTHER
RESOURCE BEYOND THE PATIENT.
DO YOU NOTICE IN TERMS OF CANCER
OUTCOMES, HAS THERE BEEN ANY
STUDIES TO LOOK AT THAT TO
DETERMINE IF YOU DO HAVE THESE
SORT OF MORE SINGLE PAYOR
MEDICAL SERVICES WITHOUT PATIENT
NEED TO CONTRIBUTE, IS THERE
EVIDENCE THAT THAT DOES IROVE
OUTCOME, CANCER OUTCOME, DO YOU
KNOW?
>> SO I'M NOT FAMILIAR WITH
STUDIES IN THE VA.
I SAW A PAPER THE OTHER DAY FOR
CANADA AND I HAVEN'T HAD A
CHANCE TO READ IT AS OF YET BUT
THERE WAS STILL SOME FINANCIAL
BURDEN.
IT MAY NOT BE TO THE EXTENT OF
WHAT WE SEE HERE GIVEN THAT THE
HEALTHCARE SYSTEM HAS -- IS
ORGANIZED THE WAY IT IS, BUT
SOME THINGS THAT I WOULD
CONSIDER, I THINK EVEN IN THOSE
SYSTEMS WHERE THERE IS COVERAGE,
THERE'S SO MANY OTHER COSTS
INDEPENDENT OF WHAT YOU PAY THE
HEALTHCARE SYSTEM FOR THAT CARE.
SO IF YOU HAVE TO DRIVE IN -- OR
EVEN IF YOU'RE FROM A RURAL
AREA, YOU'VE GOT TO DRIVE IN,
THOSE ARE COSTS, IF YOU HAVE A
SITUATION WHERE YOU HAVE TO STAY
FOR MULTIPLE DAY, ALL OF A
SUDDEN YOU'VE GOT A HOTEL COST
EVENTUALLY, IF YOU'RE TOO ILL TO
WORK, THEN YOU'VE LOST THAT
INCOME.
IF YOU'RE TOO ILL TO TAKE CARE
OF YOURSELF, THEN YOUR CAREGIVER
MAY HAVE TO REDUCE THEIR AMOUNT
OF TIME THAT THEY'RE WORKING.
SO THEY DON'T HAVE THAT INCOME.
SO I THINK EVEN OUTSIDE OF THE
DIRECT MEDICAL COSTS, THERE'S SO
MANY DOWNSTREAM THINGS THAT
COULD INCUR A COST FOR PATIENTS
AND FAMILIES THAT IT'S STILL
DIFFICULT AND CHALLENGING.
>> DAVID, DID YOU HAVE A
FOLLOW-UP TO THAT OR ANYTHING?
SO I DO HAVE ANOTHER QUESTION
FROM ONE OF OUR COLLEAGUES WHO'S
ASKING IF IT'S POSSIBLE FOR YOU
TO ELABORATE A LITTLE BIT ON
SORT OF THE BIDIRECTIONAL
INFLUENCES OF ECONOMIC
DISADVANTAGES AND MEDICAL
TREATMENT OUTCOMES, SORT OF
WHICH ASPECTS OF THE FINANCIAL
OR MEDICAL TREATMENT WOULD BE
MORE LIKELY TO CHANGE OUTCOME,
OR SHOULD YOU TRY TO TACKLE
THOSE THINGS AT THE SAME TIME?
DO YOU HAVE ANY THOUGHTS ON
THAT?
>> ?
>> I'M GOING TO READ IT IN CHAT
A LITTLE BIT TO MAKE SURE I
UNDERSTAND IT FULLY.
>> ABSOLUTELY.
>> YOU KNOW, I THINK WE DON'T
REALLY KNOW IF IT'S THE
FINANCIAL OR -- VERSUS MEDICAL
TREATMENT ASPECT.
YOU KNOW, I THINK WHAT'S TRICKY,
ESPECIALLY WHEN YOU THINK OF
ECONOMIC DISADVANTAGES, WE KNOW
THERE'S SO MANY OTHER THINGS
THAT THAT MEANS AS WELL, SO IT
MAY MEAN YOU DON'T HAVE ACCESS
TO HIGH QUALITY FOOD OR YOU'RE
MORE EXPOSED TO POLLUTION, SO IT
BECOMES REALLY TRICKY TO
DISENTANGLE ALL OF THOSE PIECES.
-- MOVE FORWARD TRYING TO DO IT
ALL.
I ALWAYS HAVE A DREAM AND A
VISION, SO --
>> RIGHT.
NO, UNDERSTOOD.
I MEAN, THERE'S A LOT TO UNPACK
HERE AND AS YOU SAID, THERE'S A
LOT TO POTENTIALLY UNTANGLE.
DR. SHURTLEFF, DID YOU HAVE ANY
OTHER QUESTIONS?
WE DID HAVE ONE QUESTION THAT
CAME IN.
DO YOU THINK THERE'S BEEN ANY
IMPACT FROM COVID-19 IN THIS
SPACE, PARTICULARLY FOR CANCER
SURVIVORS?
HAS THERE BEEN ANYTHING THAT YOU
THINK HAS BEEN AN IMPACT FROM
COVID-19?
>> RIGHT.
SO I KNOW OF ONE PUBLISHED PAPER
THAT WAS NOT IN CANCER SURVIVORS
SPECIFICALLY, BUT IT DID SHOW
THAT THERE WAS AN ECONOMIC
BURDEN OF DISEASE FOR
INDIVIDUALS WHO HAD EXPERIENCED
COVID-19, INCLUDING USING ALL
FINANCIAL RESOURCES SHORTLY
AFTER DIAGNOSIS.
AND I'M HAPPY TO SHARE THAT
CITATION AS WELL.
>> THAT WOULD BE GREAT.
>> IT'S VERY IMPORTANT BECAUSE
TODAY WE'VE THOUGHT ABOUT
CHRONIC ILLNESS, AND I KNOW
COVID-19 HAS SOME INDIVIDUALS
WHO ARE DEALING WITH IT WELL
BEYOND, BUT WE THINK OF IT AS AN
ACUTE ILLNESS PRIMARILY AND
WE'RE SEEING THAT THERE'S
ECONOMIC BURDEN OF DISEASE
WITHOUT A DOUBT.
>> OKAY, GREAT.
WELL, DAVID, ANY FINAL COMMENTS
OR THOUGHTS?
>> I JUST WANT TO THANK YOU, DR.
THIS WAS GREAT.
YOU KNOW, I'M LOOKING FORWARD
TO, AS YOU POG THROUGH PRR
RESEARCH NETWORK ON EMOTIONAL
WELL-BEING, I'M INTERESTED IN
UPDATES AND HOW THIS IS GOING.
I THINK YOU'VE HIT ON AN
IMPORTANT PUBLIC HEALTH CONCERN,
TBRANGLY, WITH
FRANKLY, WITH MANY PEOPLE
STRUGGLING WITH HEALTHCARE COST
AND THAT WILL HELP US THINK
THROUGH HOW WE CAN DO BETTER BY
PATIENTS AS THEY GO THROUGH THIS
JOURNEY.
SO THANK YOU SO MUCH FOR YOUR
PRESENTATION.
IT WAS REALLY SORT OF
THOUGHT-PROVOKING IN MANY WAYS.
SO THANK YOU.
>> YOU'RE WELCOME.
THANK YOU FOR THE OPPORTUNITY TO
SHARE THIS AREA OF RESEARCH.
>> YES, AND THANK YOU SO MUCH,
DR. MARTIN, FOR JOINING US
TODAY, AND I THINK WE'RE GOING
TO CONCLUDE THE Q & A SESSION
NOW, AND SO I WANT TO THANK OUR
VIEWERS FOR JOINING US AND FOR
SHARING THEIR QUESTIONS AND A
REMINDER THAT THIS PRESENTATION
WAS INDEED RECORDED AND WILL BE
AVAILABLE FOR LATER VIEWING ON
THE NIH VIDEO VIDEOCAST WEBSE
PAST EVENTS SECTION.
AND DON'T FORGET TO JOIN US ON
JUNE 23RD.
WE'RE GOING TO BE HERE FROM NOON
TO 1:00 P.M. EASTERN FOR OUR
THIRD AND FINAL IMLS TALK FOR
THE SPRING, WHICH IS ALSO ON THE
THEME OF EMOTIONAL WELL-BEING
AND IT'S GOING TO BE ON
ADVANCING RESEARCH ON EMOTIONAL
WELL-BEING AND REGULATION OF
EATING.
THAT'S GOING TO BE PRESENTED BY
DR. ALYSSA POWELL OF THE
UNIVERSITY OF CALIFORNIA AT
SAN FRANCISCO.
AND WITH THAT, THANK YOU SO
MUCH, DR. MARTIN.
WE ENJOYED HAVING YOU WITH US
TODAY, ENJOYED YOUR PRESENTATION
VERY MUCH, AND WE LOOK FORWARD
TO WORKING WITH YOU IN THE
FUTURE AND AS YOUR RESEARCH
PROGRESSES.
SO HAVE A WONDERFUL DAY,
EVERYBODY.
BYE-BYE.